CRANIO® The Journal of Craniomandibular & Sleep Practice
ISSN: 0886-9634 (Print) 2151-0903 (Online) Journal homepage: http://www.tandfonline.com/loi/ycra20
Multivariate Analysis of Craniomandibular Disorders Jean C. Quémar & Boris D. Lazar To cite this article: Jean C. Quémar & Boris D. Lazar (1992) Multivariate Analysis of Craniomandibular Disorders, CRANIO®, 10:2, 89-95, DOI: 10.1080/08869634.1992.11677896 To link to this article: http://dx.doi.org/10.1080/08869634.1992.11677896
Published online: 18 Feb 2016.
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Full Terms & Conditions of access and use can be found at http://www.tandfonline.com/action/journalInformation?journalCode=ycra20 Download by: [Australian Catholic University]
Date: 12 August 2017, At: 21:51
• STATISTICS
MULTIVARIATE ANALYSIS OF CRANIOMANDIBULAR DISORDERS Jean C. Quemar, D.D.S, Ph.D., Boris D. Lazar, M.D.
Downloaded by [Australian Catholic University] at 21:51 12 August 2017
0886-9634192/10020089$03.00/0, THE JOURNAL OF CRANIOMANDIBULAR PRACTICE, Copyright © 1992 by Williams & Wilkins Manuscript received August 7, 1991; revised manuscript received December 6, 1991 ; accepted December 6, 1991 Address for reprint requests: Jean C. Quemar, Ph.D. Univers~e de Rennes FacuRe de Chirurgie Dentaire UnM de Formation et de Recherche d'Odontologie 2 Place Pasteur 35000 Rennes, France
ABSTRACT: This article presents the clinical application of a special statistical method, the Multiple Correspondence Analysis (MCA), derived from data analysis and particularly suited to study a restricted population (here, 202 patients with temporomandibular joint [TMJ] disorders) whose characteristics are defined by a large number of modalities (140). Processing of a Burttype data table, or Complete Disjunctive Table (CDT), provided a geometrical visualization of information, and permitted determination of the prevalent factor axes. Results showed a significant relationship between all the articular disorders, either peripheral or focal (TMJ), thus revealing the possibility of a yet, little known morphogenic influence on the genesis of TMJ disorders.
T
emporomandibular joint (TMJ) disorders (articular and periarticular) are characterized by subjective (pain) or objective (clicks) local symptoms associated with more general dysfunctions reflected by peripheral signs that range from reflexogenous pain, localized in one or several trigger zones, to more general painful manifestations (chronic headache, cervical or cervicobrachial pain, or lumbar pain). A wide variety of inventories and TMJ scales have been used in epidemiological studies on TMJ disorders. Some authors studied the presence of signs in a very large population 1•2 or compared results from a randomized panel with those obtained from selected TMJ patients. 3 Others tried to correlate the signs they thought most significant, within a group of patients with craniomandibular disorders (CMD), but in a single plane.~ Helkimo designed a clinical dysfunction index7 to classify the clinical signs. More recently, Mongini 8 developed an index system to quantify etiopathogenic factors. Other authors have established TMJ scales9- 12 in order to insert grade symptoms within the symptom categories. Student's t test, the chi-square test, or Spearman's rank correlation was used to study the indices and subindices that provide the most objective assessment of treatments and post-treatment follow-ups. This paper presents a different approach, in that it provides a picture of a panel of patients by describing their main traits using a data analysis method. 13•14 Computations were performed with a "SPAD" system (Systeme Portable pour I' Analyse des Donnees)Y
Dr. Jean C. Quemar, has been teaching at the Faculty of Dental Surgery of the University of Rennes, France, since 1970. In 1985 he became head of one of the Departments of Fundamental Science and now coordinates the teaching of Anatomy, Physiology, and Occlusion. He took part in the creation in 1982 of a specialized Craniomandibular Disorders Unit at the Rennes Teaching Hospital. He became head of this unit in 1990.
Dr. Boris D. Lazar holds an Advanced Studies Certificate in mathematics, a doctorate in medicine, and a specialty certificate in forensic medicine. He is an Agrege of the University and a lecturer at the Mathematics Institute of the University of Rennes. To further research in algebra and logic, he is currently working on statistics research. A member of the Research Institute for the Teaching of Mathematics, he is an ex qualitas participant in a National Commission for Data Processing.
Patients and Method Patients Two-hundred two patients having consulted the CMD clinical unit of Rennes Hospital were subjected to a ques89
MULTIVARIATE ANALYSIS
QUEMAR AND LAZAR
NAME: First name: Address: Phone:
Number: Date: Date of birth: Sex:
1. TMJ Symptoms Right Bilateral Pos.l-at D Pain D Op. Click D Re. Click D Locking
2. Ear Symptoms D Ear Pain
D D
Tinnitus Imp.Hea.
Left Pos.Lat
D D D D D D D
Downloaded by [Australian Catholic University] at 21:51 12 August 2017
Muscle Symptoms Right
D D D D 0 D D D D
Left Masseter Temporalis Med. Pte. Lat. Pte. Ster. C.M. Trapez. Scalenus Supr. H. FacialM.
D D D D D D D D D
4. Peripheral Symptoms
D D D D D
Mandible D Max. (Si.) D Neck D Shoulder D Eyes (aro.) D Cerv. Spine Pain D Headaches D Nausea D Vertigo D S. Radiographic Analysis 0 AS>PS 0 0 PS>AS D D Sup.S+ D D Sup.SD 6. Relation with Clinical Symptoms D Pain D D Op. Click D D Rec. Click D D Locking D
B. ANAMNESIS How long have you been bothered by this problem? Years: Months: Weeks: Days: Have you had previous treatment? (If yes, explain): Have you had any accident or injury to the jaw or face? (If yes, explain): Do you have other articular problems (i.e., arthritis)? (If yes, where?): Have you had a cervicospinal adjustment? Have you had any other treatment for articular problems? (If yes, explain: drugs, exercise, dental appliance) Have you had your teeth straightened? (orthodontia)? Have you had your bite adjusted by your dentist? Psychiatric evaluation: Are you undergoing personal problems (divorce, unemployment)? (If yes, explain): Do you know if you clench your teeth? Has anyone mentioned that you grind your teeth (bruxism)? Are you currently under pain medication? If yes, what kind and how much? Do you have an oral habit (chew gum,
-~
Right
Left
D
D
D
D
D D
D D
D
D
D
D
D
D
D
D
D
D
D
D
D
D
D
D
Is there anyone else in your family with a similar problem? (If yes, explain): D D Please list names of doctors you have seen in the past for this or related problems.
Please write any other relevant information that has not been covered previously.
7. Occlusion and Tooth Examination Angle class: D Cusp.Pro. Group.Fon. D
Additonal data:
D D
Figure lA and lB. Clinical examination sheet.
tionnaire (Figure lA and lB) that permitted rapid recovering of subjective (articular or associated pain) and objective (TMJ noises or locking) symptoms, radiographic normality of articular space (TRs), and the patients' anamnesis. Patients' mean age was 31 years and 10 months, with
90
THE JOURNAL OF CRANIOMANDIBULAR PRACTICE
a standard deviation of 10 years and 9 months. Sex distribution was 15% men and 85% women. It was worth noting that 87% of the patients were 15 to 44 years old and that young adults were predominant (Table 1). The most frequent symptoms could be ranked in decreasing order of incidence (Table 2) but this type of classification APRIL 1992, VOL 10, NO.2
MULTIVARIATE ANALYSIS
QUEMAR AND LAZAR
does not give a precise pattern of the correlations that may exist between some of them.
Table 1 Distribution of Patients as to Age and Sex
=
Method
~e· fk it it ; ; :
Age
4S-S4
ranging 35-44
:ZS-34
15·24
.
~
0
II Male iJ
;
~
~
~
•
The method used was factor analysis, derived from data analysis, and more specifically multiple correspondence analysis (MCA), which is well adapted to analyzing survey results. Data Encoding. Forty-two variables, each representing a questionnaire item, led to 140 modalities. For instance, the TMJ-pain variable includes 10 modalities: no pain (NPa), right lateral pain (RLP), . . . bilateral posterior pain (BPP). These variables, whose modalities exclude one another, are qualitative. All the variables, through their various modalities, result in a complete disjunctive table (COT). Each line represents a patient whose answers to a given modality are encoded 0 (no or negative response) or 1 (positive). Modality encoding provides an N-line and N'-column table where N is the size of the panel, i.e., the number of patients, and N' is the total number of modalities considered. For instance, in Table 3A, the shaded line represents the questionnaire answers by patient No. 22 whose age is in the 25 to 34 bracket and who presented with right lateral pain (RLP), right TMJ crepitus (RCr), etc. These answers correspond to the COT line of the table effectively analyzed (Table
II Female
16
~
~
~
Downloaded by [Australian Catholic University] at 21:51 12 August 2017
Number of patients
Table 2 Incidence Percentage of Main Symptoms in Patients :!4.8%
SHOULDER PAIN
27.7'1D
CERVICOSPINAL PAIN
27.7'fo
MASSETER PAIN
30.2%
CLENCHING HEADACHES
31.2%
CREPITUS
31.7'11 33.8%
OPENING CLICK
39.6%
NECK PAIN
56.5%
A.S.>P.S. TMJ PAIN
. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ~-'%
3B). Statistics. Factor analysis consists of introducing, with
algebraic and geometric methods, euclidian vectors that Table 3 Data Encoding
item
1
2
3
4
5
6
7
8
9 10 11 12 13 14 15 16 1 7 18 19 20 21 22 23 24 25 26 27 28 29 30 31 32 33 34 35 36 37 38 39 40 41 42
1 2
4 3
3 3
5 8
1 3
1 1
1 1
1 1
1 1
1 1
22
3
3
3
1
1 I
t
t I
atient
2 1
I
2 1
1 1
~
~
1 1
1
1 1
2 3
1 1
1 1
1 1
1 1
1 1
1
I
f
t
t
1
''
1 1
1 1
1 1
1 1
1 1 I
1 1
1 1
1 1
1 2
2 2
1 1
1
t
1
,
I
1 I
2 2
1 1
1 2
2 1
1 I
2 1
1 '1
2 1
1 1
2 2
1 1
., ,:a .:··
·.t;
2 1
1 1
2 1
\ti \'1' 1:
A. Example of data encoding (patient No. 22).
modahte 15.24 25.34 35.44 45.54 55.64 >65 m. I. at•cnt 1 2
0 0
22
0
0
0 0
0 0
0 0
0
0
0
0
0
0
p. rla.P lla.P lrp.P lip.P bla.Pibp.P lrpla. lipia.PibPia ocl r.oc l.ocl b.oc rei r.rc l.rcl b.rc cro r.cr l.cro b.cro 1 1
0 0
1
0
0 0
0
0 0
0
0
0
0
0
0
0
0
0 0
1 0
0 0
0
0
1
0
0
0 0
1 1
0 0
0 0
:·0 . 1
.·:o
·0
0 0
1 1
0 0
0 0
0 0
iO :r.-:-:·>::1
::~::o
7'
ISSN: 0886-9634 (Print) 2151-0903 (Online) Journal homepage: http://www.tandfonline.com/loi/ycra20
Multivariate Analysis of Craniomandibular Disorders Jean C. Quémar & Boris D. Lazar To cite this article: Jean C. Quémar & Boris D. Lazar (1992) Multivariate Analysis of Craniomandibular Disorders, CRANIO®, 10:2, 89-95, DOI: 10.1080/08869634.1992.11677896 To link to this article: http://dx.doi.org/10.1080/08869634.1992.11677896
Published online: 18 Feb 2016.
Submit your article to this journal
Article views: 1
View related articles
Full Terms & Conditions of access and use can be found at http://www.tandfonline.com/action/journalInformation?journalCode=ycra20 Download by: [Australian Catholic University]
Date: 12 August 2017, At: 21:51
• STATISTICS
MULTIVARIATE ANALYSIS OF CRANIOMANDIBULAR DISORDERS Jean C. Quemar, D.D.S, Ph.D., Boris D. Lazar, M.D.
Downloaded by [Australian Catholic University] at 21:51 12 August 2017
0886-9634192/10020089$03.00/0, THE JOURNAL OF CRANIOMANDIBULAR PRACTICE, Copyright © 1992 by Williams & Wilkins Manuscript received August 7, 1991; revised manuscript received December 6, 1991 ; accepted December 6, 1991 Address for reprint requests: Jean C. Quemar, Ph.D. Univers~e de Rennes FacuRe de Chirurgie Dentaire UnM de Formation et de Recherche d'Odontologie 2 Place Pasteur 35000 Rennes, France
ABSTRACT: This article presents the clinical application of a special statistical method, the Multiple Correspondence Analysis (MCA), derived from data analysis and particularly suited to study a restricted population (here, 202 patients with temporomandibular joint [TMJ] disorders) whose characteristics are defined by a large number of modalities (140). Processing of a Burttype data table, or Complete Disjunctive Table (CDT), provided a geometrical visualization of information, and permitted determination of the prevalent factor axes. Results showed a significant relationship between all the articular disorders, either peripheral or focal (TMJ), thus revealing the possibility of a yet, little known morphogenic influence on the genesis of TMJ disorders.
T
emporomandibular joint (TMJ) disorders (articular and periarticular) are characterized by subjective (pain) or objective (clicks) local symptoms associated with more general dysfunctions reflected by peripheral signs that range from reflexogenous pain, localized in one or several trigger zones, to more general painful manifestations (chronic headache, cervical or cervicobrachial pain, or lumbar pain). A wide variety of inventories and TMJ scales have been used in epidemiological studies on TMJ disorders. Some authors studied the presence of signs in a very large population 1•2 or compared results from a randomized panel with those obtained from selected TMJ patients. 3 Others tried to correlate the signs they thought most significant, within a group of patients with craniomandibular disorders (CMD), but in a single plane.~ Helkimo designed a clinical dysfunction index7 to classify the clinical signs. More recently, Mongini 8 developed an index system to quantify etiopathogenic factors. Other authors have established TMJ scales9- 12 in order to insert grade symptoms within the symptom categories. Student's t test, the chi-square test, or Spearman's rank correlation was used to study the indices and subindices that provide the most objective assessment of treatments and post-treatment follow-ups. This paper presents a different approach, in that it provides a picture of a panel of patients by describing their main traits using a data analysis method. 13•14 Computations were performed with a "SPAD" system (Systeme Portable pour I' Analyse des Donnees)Y
Dr. Jean C. Quemar, has been teaching at the Faculty of Dental Surgery of the University of Rennes, France, since 1970. In 1985 he became head of one of the Departments of Fundamental Science and now coordinates the teaching of Anatomy, Physiology, and Occlusion. He took part in the creation in 1982 of a specialized Craniomandibular Disorders Unit at the Rennes Teaching Hospital. He became head of this unit in 1990.
Dr. Boris D. Lazar holds an Advanced Studies Certificate in mathematics, a doctorate in medicine, and a specialty certificate in forensic medicine. He is an Agrege of the University and a lecturer at the Mathematics Institute of the University of Rennes. To further research in algebra and logic, he is currently working on statistics research. A member of the Research Institute for the Teaching of Mathematics, he is an ex qualitas participant in a National Commission for Data Processing.
Patients and Method Patients Two-hundred two patients having consulted the CMD clinical unit of Rennes Hospital were subjected to a ques89
MULTIVARIATE ANALYSIS
QUEMAR AND LAZAR
NAME: First name: Address: Phone:
Number: Date: Date of birth: Sex:
1. TMJ Symptoms Right Bilateral Pos.l-at D Pain D Op. Click D Re. Click D Locking
2. Ear Symptoms D Ear Pain
D D
Tinnitus Imp.Hea.
Left Pos.Lat
D D D D D D D
Downloaded by [Australian Catholic University] at 21:51 12 August 2017
Muscle Symptoms Right
D D D D 0 D D D D
Left Masseter Temporalis Med. Pte. Lat. Pte. Ster. C.M. Trapez. Scalenus Supr. H. FacialM.
D D D D D D D D D
4. Peripheral Symptoms
D D D D D
Mandible D Max. (Si.) D Neck D Shoulder D Eyes (aro.) D Cerv. Spine Pain D Headaches D Nausea D Vertigo D S. Radiographic Analysis 0 AS>PS 0 0 PS>AS D D Sup.S+ D D Sup.SD 6. Relation with Clinical Symptoms D Pain D D Op. Click D D Rec. Click D D Locking D
B. ANAMNESIS How long have you been bothered by this problem? Years: Months: Weeks: Days: Have you had previous treatment? (If yes, explain): Have you had any accident or injury to the jaw or face? (If yes, explain): Do you have other articular problems (i.e., arthritis)? (If yes, where?): Have you had a cervicospinal adjustment? Have you had any other treatment for articular problems? (If yes, explain: drugs, exercise, dental appliance) Have you had your teeth straightened? (orthodontia)? Have you had your bite adjusted by your dentist? Psychiatric evaluation: Are you undergoing personal problems (divorce, unemployment)? (If yes, explain): Do you know if you clench your teeth? Has anyone mentioned that you grind your teeth (bruxism)? Are you currently under pain medication? If yes, what kind and how much? Do you have an oral habit (chew gum,
-~
Right
Left
D
D
D
D
D D
D D
D
D
D
D
D
D
D
D
D
D
D
D
D
D
D
D
Is there anyone else in your family with a similar problem? (If yes, explain): D D Please list names of doctors you have seen in the past for this or related problems.
Please write any other relevant information that has not been covered previously.
7. Occlusion and Tooth Examination Angle class: D Cusp.Pro. Group.Fon. D
Additonal data:
D D
Figure lA and lB. Clinical examination sheet.
tionnaire (Figure lA and lB) that permitted rapid recovering of subjective (articular or associated pain) and objective (TMJ noises or locking) symptoms, radiographic normality of articular space (TRs), and the patients' anamnesis. Patients' mean age was 31 years and 10 months, with
90
THE JOURNAL OF CRANIOMANDIBULAR PRACTICE
a standard deviation of 10 years and 9 months. Sex distribution was 15% men and 85% women. It was worth noting that 87% of the patients were 15 to 44 years old and that young adults were predominant (Table 1). The most frequent symptoms could be ranked in decreasing order of incidence (Table 2) but this type of classification APRIL 1992, VOL 10, NO.2
MULTIVARIATE ANALYSIS
QUEMAR AND LAZAR
does not give a precise pattern of the correlations that may exist between some of them.
Table 1 Distribution of Patients as to Age and Sex
=
Method
~e· fk it it ; ; :
Age
4S-S4
ranging 35-44
:ZS-34
15·24
.
~
0
II Male iJ
;
~
~
~
•
The method used was factor analysis, derived from data analysis, and more specifically multiple correspondence analysis (MCA), which is well adapted to analyzing survey results. Data Encoding. Forty-two variables, each representing a questionnaire item, led to 140 modalities. For instance, the TMJ-pain variable includes 10 modalities: no pain (NPa), right lateral pain (RLP), . . . bilateral posterior pain (BPP). These variables, whose modalities exclude one another, are qualitative. All the variables, through their various modalities, result in a complete disjunctive table (COT). Each line represents a patient whose answers to a given modality are encoded 0 (no or negative response) or 1 (positive). Modality encoding provides an N-line and N'-column table where N is the size of the panel, i.e., the number of patients, and N' is the total number of modalities considered. For instance, in Table 3A, the shaded line represents the questionnaire answers by patient No. 22 whose age is in the 25 to 34 bracket and who presented with right lateral pain (RLP), right TMJ crepitus (RCr), etc. These answers correspond to the COT line of the table effectively analyzed (Table
II Female
16
~
~
~
Downloaded by [Australian Catholic University] at 21:51 12 August 2017
Number of patients
Table 2 Incidence Percentage of Main Symptoms in Patients :!4.8%
SHOULDER PAIN
27.7'1D
CERVICOSPINAL PAIN
27.7'fo
MASSETER PAIN
30.2%
CLENCHING HEADACHES
31.2%
CREPITUS
31.7'11 33.8%
OPENING CLICK
39.6%
NECK PAIN
56.5%
A.S.>P.S. TMJ PAIN
. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ~-'%
3B). Statistics. Factor analysis consists of introducing, with
algebraic and geometric methods, euclidian vectors that Table 3 Data Encoding
item
1
2
3
4
5
6
7
8
9 10 11 12 13 14 15 16 1 7 18 19 20 21 22 23 24 25 26 27 28 29 30 31 32 33 34 35 36 37 38 39 40 41 42
1 2
4 3
3 3
5 8
1 3
1 1
1 1
1 1
1 1
1 1
22
3
3
3
1
1 I
t
t I
atient
2 1
I
2 1
1 1
~
~
1 1
1
1 1
2 3
1 1
1 1
1 1
1 1
1 1
1
I
f
t
t
1
''
1 1
1 1
1 1
1 1
1 1 I
1 1
1 1
1 1
1 2
2 2
1 1
1
t
1
,
I
1 I
2 2
1 1
1 2
2 1
1 I
2 1
1 '1
2 1
1 1
2 2
1 1
., ,:a .:··
·.t;
2 1
1 1
2 1
\ti \'1' 1:
A. Example of data encoding (patient No. 22).
modahte 15.24 25.34 35.44 45.54 55.64 >65 m. I. at•cnt 1 2
0 0
22
0
0
0 0
0 0
0 0
0
0
0
0
0
0
p. rla.P lla.P lrp.P lip.P bla.Pibp.P lrpla. lipia.PibPia ocl r.oc l.ocl b.oc rei r.rc l.rcl b.rc cro r.cr l.cro b.cro 1 1
0 0
1
0
0 0
0
0 0
0
0
0
0
0
0
0
0
0 0
1 0
0 0
0
0
1
0
0
0 0
1 1
0 0
0 0
:·0 . 1
.·:o
·0
0 0
1 1
0 0
0 0
0 0
iO :r.-:-:·>::1
::~::o
7'
